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The retinopathy‐derived HbA1c threshold of 6.5% for type 2 diabetes also captures the risk of diabetic nephropathy in NHANES

Version 2 2024-10-27, 14:08
Version 1 2023-03-15, 13:05
journal contribution
revised on 2024-10-27, 14:04 and posted on 2024-10-27, 14:08 authored by Stephen L. Atkin, Alexandra E. Butler, Steven C. Hunt, Eric S. Kilpatrick

Aim

To determine if an HbA1c diagnostic threshold of less than 6.5% (<48 mmol/mol) could be identified based on a urinary albumin-creatinine ratio (UACR) of 30 mg/g or higher in subjects not known to have diabetes.

Methods

A UACR was measured for 20 158 participants in the 2011-2018 nationally representative cross-sectional National Health and Nutrition Examination Surveys (NHANES; cycles 7-10 inclusive).

Results

There was a significant trend for an increasing risk with a UACR of 30 mg/g or higher across increasing HbA1c categories (P < .0001). This trend was mainly attributable to the high prevalence of raised UACR in the 7.0% or higher HbA1c subgroup of subjects not previously diagnosed with diabetes. None of the odds ratios in the lower HbA1c subgroups versus the HbA1c subgroup of less than 5.0% reached significance. There were racial/ethnic differences in UACR risk (P < .0001), with White and Black subjects exhibiting little increased risk (vs. HbA1c <5.0%) until they reached an HbA1c of 7.0%, while Asian and Hispanic subjects showed some increased, but non-significant, risks at lower HbA1c levels. Maximizing the area under receiver operating characteristic curves from logistic regressions predicted an ideal HbA1c threshold of 5.8%, but there was little variation in area from 5.5% to 7.0%.

Conclusion

A clinically useful diagnostic threshold below 6.5% for HbA1c for elevated UACR risk was not identified, with an increased risk only obvious at an HbA1c of 7.0% or higher. Thus, the retinopathy-derived HbA1c threshold of 6.5% also captures the risk of diabetic nephropathy in NHANES.

Other Information

Published in: Diabetes, Obesity and Metabolism
License: http://creativecommons.org/licenses/by-nc/4.0/
See article on publisher's website: http://dx.doi.org/10.1111/dom.14449

History

Language

  • English

Publisher

Wiley

Publication Year

  • 2021

License statement

This Item is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License.

Institution affiliated with

  • Hamad Bin Khalifa University
  • Qatar Biomedical Research Institute - HBKU
  • Diabetes Research Center - QBRI
  • Weill Cornell Medicine - Qatar

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